Hyponatremia in Kawasaki disease

Abstract

Although hyponatremia frequently occurs in Kawasaki disease (KD), the clinical characteristics of KD patients with hyponatremia and the pathogenesis of hyponatremia in KD remain unknown. The aims of this study were to define the clinical characteristics of KD patients with hyponatremia (serum sodium <135 mEq/l) and to determine the factors associated with its development. One hundred and fourteen patients with KD were included in this study. Fifty-one patients (44.7%) had hyponatremia. Coronary artery lesions and dehydration were significantly more common in patients with hyponatremia. The duration of fever was significantly longer in patients with hyponatremia. Pyuria and hematuria were present significantly more often in patients with hyponatremia. The serum concentrations of potassium, chloride and total cholesterol were significantly lower in patients with hyponatremia. Serum C-reactive protein and alanine aminotransferase were significantly higher in patients with hyponatremia. Some patients with pyuria and hyponatremia exhibited increased excretion of urinary tubular epithelial cells and urinary casts. There was no difference in the incidence of diarrhea between patients with hyponatremia and patients without hyponatremia. These results indicate that hyponatremia in KD occurs in patients exhibiting severe inflammation. Further studies will be necessary to confirm the pathogenic mechanisms of hyponatremia in patients with KD.

Immunoglobulin preparations affect hyponatremia in Kawasaki disease

“…It is known that patients with KD also frequently develop hyponatremia [4,7,10]. Our present study disclosed that the prevalence of hyponatremia is nearly one third of the patients with KD, which is in agreement with the previous reports [4,10].…”

“…Our present study disclosed that the prevalence of hyponatremia is nearly one third of the patients with KD, which is in agreement with the previous reports [4,10]. It has been proposed that mechanisms for hyponatremia in KD are associated with the syndrome of inappropriate antidiuretic hormone secretion (SIADH), hyponatremic dehydration, and ingestion of fluid that is hypo-osmolar relative to the fluid loss [4,8,10].…”

“…This finding suggests that increased inflammatory cytokines may induce SIADH and also have direct tubular effects causing natriuresis as suggested by several authors [8,10].…”

“…KD was diagnosed according to the diagnostic guidelines by Burns and Glodé [1], and CALs were assessed by echocardiography and were defined by either (1) an internal diameter of the coronary artery lumen >3 mm in a child <5 years or >4 mm in a child ≥5 years, (2) the internal diameter of a segment's being at least 1.5 times as large as that of an adjacent segment, or (3) when the lumen was clearly irregular [10]. Hyponatremia was defined as serum Na level <135 mEq/L [4,7,10].…”

Hyponatremia in lower respiratory tract infections

“…2,3 Hyponatremia often develops in acute inflammatory diseases such as meningitis, respiratory tract infections, febrile convulsions, and Kawasaki disease in children. [4][5][6][7] Patients with pneumonia and bronchiolitis, the most common diseases encountered in pediatric general practice, are at particular risk of developing hyponatremia due to antidiuretic hormone (ADH) oversecretion. [8][9][10][11] Hyponatremia associated with paediatric pneumonia is most commonly due to the syndrome of inappropriate antidiuretic hormone secretion (SIADH).…”